Multiple Sclerosis is an autoimmune chronic inflammatory disease, characterized by a progressive demyelination of the central nervous system. While its origin still remains unknown, its multifactorial etiology is well known, consisting of a clear genetic component regulated by several environmental factors.
Clinical evolution of MS is very heterogeneous, and there are different phenotypes present. These range from a very severe form where patients worsen rapidly (known as primary progressive MS), to a more benign form, where the patient practically recovers completely after each disease relapse (known as relapsing remitting MS). Nowadays, disease diagnostics is clinically based, relying on three main points: clinical history, neurologic exploration and use of several techniques (Magnetic Resonance Imaging, analysis of cerebrospinal fluid and evoked potentials).
Currently there is no treatment that will cure MS. MS therapies aim at controlling symptoms and maintaining patient's quality of life. With such treatments, the number of relapses is controlled to a certain level, allowing partial prevention of consequences that may cause such relapses. The primary aims of therapy are returning function after an attack, preventing new attacks, and preventing disability. As with any medical treatment, medications used in the management of MS have several adverse effects. Disease-modifying treatments reduce the progression rate of the disease, but do not stop it. As multiple sclerosis progresses, the symptomatology tends to increase. The disease is associated with a variety of symptoms and functional deficits that result in a range of progressive impairments and disability.
Management of these deficits is therefore very important. Both drug therapy and neurorehabilitation have shown to ease the burden of some symptoms, though neither influences disease progression. As for any patient with neurologic deficits, a multidisciplinary approach is key to limiting and overcoming disability; however, there are particular difficulties in specifying a ‘core team’ because people with MS may need help from almost any health profession or service at some point. Similarly, for each symptom there are different treatment options. Treatments should therefore be individualized depending both on the patient and the physician.